Radiographic and Histomorphometric Analysis of a Xenograft S1-XB for Socket Preservation in Maxillary Posterior Teeth: A Randomized Controlled Clinical Study

Background Socket preservation aims to minimize post-extraction ridge resorption. This randomized controlled clinical trial evaluated the radiographic and histomorphometric outcomes of a bovine-derived xenograft combined with alginate hydrogel (S1-XB) compared with natural healing. Aim This study investigated the radiographic and histomorphometric outcomes of socket preservation with a bovine-derived xenograft combined with alginate hydrogel (S1-XB) compared to natural healing in maxillary posterior extraction sites. Materials and Methods Sixteen male patients (21–40 years) requiring atraumatic extraction of maxillary posterior teeth were randomly assigned (1:1) to S1-XB grafting (n = 8) or natural healing (n = 8). Cone-beam computed tomography (CBCT) was performed immediately post-extraction and after 4 months to assess bone density, ridge height, and ridge width. Core biopsies harvested at 4 months were analyzed using H&E, Masson's trichrome, and osteopontin immunohistochemistry. The primary outcome was CBCT-based bone density at 4 months. Secondary outcomes included ridge dimensions, bone area, osteoid, intertrabecular tissue, and osteopontin expression. Results All 16 randomized participants completed the study. Bone density was significantly higher in the grafted group compared with controls (748.66 ± 90.19 HU vs. 514.33 ± 177.58 HU; p < 0.001). Histomorphometry showed significantly greater bone area and lower osteoid and intertrabecular tissue in the grafted sockets. Ridge height and width did not differ significantly between groups. No adverse events occurred. Conclusions S1-XB xenograft significantly enhanced bone density and histological bone quality without altering ridge dimensions at 4 months. The material appears effective for socket preservation prior to implant placement. Trial was retrospectively registered on Clinicaltrials.gov , TNR: NCT07250256 , 11/25/2025